Provider Demographics
NPI:1780623389
Name:CHANG, ROXANNE SUI TZE PAN (MD)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:SUI TZE PAN
Last Name:CHANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21081 S WESTERN AVE
Mailing Address - Street 2:SUITE 295
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1703
Mailing Address - Country:US
Mailing Address - Phone:310-533-6600
Mailing Address - Fax:
Practice Address - Street 1:21081 S WESTERN AVE
Practice Address - Street 2:SUITE 295
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1703
Practice Address - Country:US
Practice Address - Phone:310-533-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044102208000000X
CAA78427208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAI29585Medicare UPIN